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All About Pre-Existing Coverage In Health Insurance Plans?

Updated On Sep 08, 2022

A pre-existing illness is defined as an illness or medical condition that the insured had before acquiring health insurance is referred to as a pre-existing condition. According to IRDAI, a condition is considered pre-existing if the insured had it diagnosed up to 48 months prior to purchasing the insurance. All chronic medical diseases, such as high blood pressure, thyroid problems, and diabetes, are considered pre-existing conditions. such as asthma.

All About Pre-Existing Coverage In Health Insurance Plans?

Pre-Existing Conditions Waiting Time

After a waiting time, the majority of health insurance policies cover pre-existing conditions. Any claim submitted for the treatment of a pre-existing condition will be denied by your insurance company during this time. Pre-existing disease waiting periods often last between two and four years.

All health plans do not have the same waiting period for pre-existing conditions. While some health insurance plans offer a two-year waiting period for diseases, other health insurance plans may cover the same disease after a four-year wait. It is advised that you change to a new insurance company only when your waiting period is over.

Tips On Purchasing Health Insurance If You Have A Condition 

People with pre-existing conditions frequently need to get a pre-policy medical exam before they may purchase medical insurance. The insurance company's premium will be based on the findings of the medical examination. Pre-acceptance health examinations may also result in the insurer's refusal to sell the policy or a reduction in the policy's coverage.

Even if you have a pre-existing condition, the following helpful advice can still help you discover the best health insurance plan:

  • Pre-Existing Disease Coverage Can Be Accessed After 48 Months

Having a pre-existing ailment can make it difficult to obtain health insurance. The most recent IRDAI standards, however, only allow health insurance firms to look at the past 48 months of medical history when determining whether a patient has a pre-existing condition. As a result, 48 months after your pre-existing ailment was discovered or treated, you can get health insurance that covers pre-existing conditions.

  • Don't Cover Up A Pre-Existing Condition

Avoid concealing any pre-existing medical conditions from your insurance provider when you are purchasing the policy. This is crucial because the insurer may deny your health insurance claim if your pre-existing condition is disclosed at the time of treatment.

  •  Every Visit To The Doctor Does Not Constitute A Pre-Existing Disease

Health insurance providers only assess long-term conditions when determining whether you have a pre-existing disease. Therefore, do not worry if you frequently get the flu, a cough, a cold, or a fever. Because they don't have long-term impacts, short-term health difficulties won't be taken into account as pre-existing conditions by the insurance provider.

  • Select A Medical Plan With A Shorter Ped Waiting Period.

There is a pre-existing sickness waiting period that prevents you from making a claim for a predetermined amount of time, regardless of whether you purchase an individual health plan or a family health insurance plan. Any claim made for these disorders during this time period will be denied by your insurance provider.

Additionally, the length of the waiting period may vary depending on the insurance policy. The duration and severity of your underlying illness also have a role. As a result, you ought to select a health insurance plan with a shorter waiting period for pre-existing conditions.

  • Steer Clear Of Health Plans That Require Co-Payments 

There may be a co-payment requirement for coverage of pre-existing conditions with some health insurance companies. In accordance with this provision, you will be required to contribute a portion of the claim amount during claim settlement, and the insurer will cover the remaining balance. However, not all health insurance policies include this co-payment provision for covering pre-existing conditions. Consequently, purchase a health plan without a co-payment provision.


Therefore, you are still eligible for health insurance coverage even if you have a pre-existing condition. Just be sure to verify your health insurance's pre-existing disease waiting period.

Also read: Health Insurance Plans For Women

Health Insurance Plans For Critical Illness


This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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